Training posts

“Everyone is applying for everything out of fear of not being able to have a stable income. “The BMA has put pressure on the Government to come up with a better solution because, from a financial perspective, the tax payer is paying to train each medical student. “And if they can’t find a job there is no solution other than to look elsewhere for employment or to look abroad.” The NHS is currently short of around 8,850 doctors. The UK has fewer doctors and nurses per person than most of its peer countries, with billions of pounds of taxpayers’ money being spent every year on agency staff.

NHS training bottlenecks

DAUK has highlighted the issue of bottlenecks in specialty training in blogs by members of our medical student committee. Dr Novintan said that she also faces a ‘bottleneck’ after two years of core surgical training. She told LBC: “I’ve done my foundation training and have finished two years of core surgical training. Then I tried to apply for surgical specialty training, but was unsuccessful. “I’m now skilled as a surgeon. It’s important to maintain our skillset, or we will lose the skills we’ve been working tirelessly for.” Listen to Dr Novintan’s interview on the DAUK Instagram at https://www.instagram.com/p/DNDG4A_Mqs0/?hl=en and https://www.instagram.com/p/DNDHpc3MIG4/?hl=en Please support our work by contributing to our crowd funder or by becoming a member.

Ms Fernandes had been co-chair alongside Dr Matt Kneale, who stood down from DAUK’s executive committee at the AGM.

We would like to express our profound thanks to Dr Kneale for his leadership, dedication, and contribution to DAUK during his time as co-chair.

Ms Fernandes said: “I am delighted to continue on now as Chair of DAUK, for what looks like a busy year ahead.

“I am very grateful for the support of my committee and admin team. Matt will be missed, but I know he is only a phone call away. I expect to call him often.”

Dr Ellen Welch is DAUK’s new vice-chair and Dr Elissa Abi-Raad continues as treasurer.

Dr Lizzie Toberty continues as GP lead, Shonelly Novintan is DAUK’s Learn Not Blame lead, Dr Matt Lee remains sustainability lead, Dr Pushpo Hossain continues as IMG lead and Maya Machesney is the new student lead.

The AGM heard a round-up of some of DAUK’s work and achievements.

Physician associates

DAUK is actively involved in the national discourse around the roles of physician associates (PAs) and anaesthesia associates (AAs).

Our committee members have been vocal in the media, raising concerns about the roles and the regulation of PAs and AAs by the General Medical Council (GMC).

More than 2,800 doctors signed a letter from DAUK to the GMC, warning the proposed regulation of PAs and AAs will undermine standards and put patients at risk.

We briefed politicians in the House of Commons and House of Lords on the draft Anaesthesia Associates and Physician Associates Order 2024, the legislation for the regulation of non-doctors by the GMC, as it passed through Parliament.

We responded to the GMC consultation on their regulation, highlighting the widespread concern on the lack of scope and standards in what is being proposing.

Our correspondence with the GMC has been published on the DAUK website and shared with the media.

We have given our support and contributed financially to a legal challenge by Anaesthetists United to the GMC regulation of PAs and AAs.

Anaesthetists United says the distinction is blurred between doctors and non-doctors, and that patients should be able to know the difference.

DAUK will not let up on the issue of PAs and AAs. We firmly believes that the future of the medical profession and the patients it looks after are at risk.

Dr Jenny Vaughan

We were deeply saddened by the death our dearest friend and colleague Dr Jenny Vaughan.

Jenny was a founding member of DAUK, a past chair, and absolutely lived and breathed the Association.

Members paid tribute to her on our Wall of Support on the DAUK website, and there were touching obituaries in the Guardian, the BMJ, and on BBC Radio 4’s Last Word.

We are planning a memorial day for Jenny next year, and more details will be announced in due course.

GP crisis

Our GP committee has been extremely busy highlighting the issues that face general practice.

Dr Ellen Welch’s book, Why Can’t I See My GP?, has been a cornerstone of their work with a copy sent to every MP to help them understand general practice and to make it a key issue this general election.

Dr Welch featured in the Daily Mail, the Sunday Times, i News and the Daily Express, and she was interviewed on Sky News, BBC Radio 5Live and BBC Radio Cumbria – among others.

Her book prompted debate on ITV’s Good Morning Britain about which types of ailments people should see their GP with, and whether children should be taught in schools how to use and access the NHS.

One of the key successes has been the prolific work on social media of Dr Steve Taylor, who produces a wealth of data and statistics on the NHS and general practice.

It’s helped Dr Taylor build an extensive following, including with health journalists, and insert him and DAUK into social media conversations.

GMC

DAUK co-chairs Helen Fernandes and Matt Kneale were invited to join the GMC Annual Symposium, which was held shortly before the release of the new Good Medical Practice.

Ms Fernandes and Dr Kneale have held quarterly meetings with the chair, chief executive and head of education of the GMC.

The meetings have been of a robust nature as we attempt to hold them to task.

To that end, in our regular GMC case in focus on the website Pulse, we highlighted the case of Dr Steven Zaw, a secondary care doctor who was suspended for ‘inadequately supervising’ the PA under his authority.

The article, which focused on PAs and supervision, was Pulse’s most read of the year so far.

NHS Practitioner Health

We highlighted a move by NHS England to immediately stop the funding for hospital doctors referred for help to NHS Practitioner Health. Those who support doctors through Practitioner Health were also told just the week before it was due to be closed.

One of our members, at that meeting, anonymously tipped us off.

We launched a social media campaign and highlighted the NHS England plans in the media and the decision was reversed less than a week later.

Dr Sarah Benn

We launched an online survey asking for the views of our members, healthcare professionals, and the public on the case of Dr Sarah Benn.

Dr Benn, a GP for 32 years, was suspended from the medical register following her participation in peaceful climate protests.

The survey was highlighted by Pulse, and the results are being reviewed and will be published in due course.

We issued a statement that we were ‘shocked and saddened’ by the sanction handed down to Dr Benn following her Medical Practitioners Tribunal Service hearing, which was picked up by the media, including BBC Online.

DAUK’s Dr Steve Taylor, meanwhile, wrote a letter to the Times on the case and the discussions around it, saying that protesting would not affect clinical judgement or trustworthiness.

Climate crisis

We joined Plant-Based Health Professionals UK (PBHP UK) to highlight serious concerns from the medical profession over the Government-backed Let’s Eat Balanced campaign.

Dr Matt Lee, DAUK’s sustainability lead, and Dr Shireen Kassam, director of PBHP UK, have co-written an open letter to the Agriculture and Horticulture Development Board (AHDB) and the Department for Environment, Food and Rural Affairs (DEFRA) to express their deep concerns at the high level of misinformation within the campaign, and ask for the campaign to be retracted.

The letter was reported in a number of publications including the Independent and openDemocracy.

Chris Packham supported our essay-writing competition for medical students on the subject of biodiversity.

Mr Packham, the broadcaster, environmental activist, and animal welfare campaigner, will guest judge the shortlisted finalists.

NHS data

We collaborated with tech-justice non-profit Foxglove and other groups to challenge the award of the biggest IT contract in the history of the NHS to US tech giant Palantir.

DAUK’s Dr David Nicholl spoke to the Sunday Mirror, describing the £330m seven-year agreement as ‘a poor deal for taxpayers and patients’.

He told our website it had not undergone sufficient public scrutiny.

NHS whistleblowing

DAUK supports the proposal for the Office of the Whistleblower and is working with not for profit organisation Whistleblowers UK to change how society thinks about whistleblowing.

DAUK’s Dr David Nicholl joined politicians, health leaders, and campaigners for a Westminster roundtable organised by the All-Party Parliamentary Group (APPG) on Whistleblowing.

Dr Nicholl also highlighted our work to protect NHS whistleblowers at the Medical Journalists’ Association’s (MJA) symposium on Building Trust in Health Journalism.

The symposium was supported by DAUK and gave our committee members the chance to hear presentations on a range of issues, and to make contact and build relationships with key health and medical journalists.

Overseas NHS Workers Day

The NHS came together for our fourth annual Overseas NHS Workers Day on Friday 1 March.

Overseas NHS Workers Day is now a firm fixture in the calendar and provides a chance to celebrate the incredible contribution they make to the NHS and the health of our nation.

Social media was full of videos, photos and the stories of our international colleagues, using the hashtag #OverseasNHSWorkersDay.

Trusts displayed flags representing the countries of birth of overseas staff; colleagues wore blue and green, the colours of the day, and some even had an international-themed lunch.

Academic foundation jobs

We sent an open letter to all medical school deans urging them to unite in opposition to changes to the allocation of academic foundation jobs.

We believe UKFPO’s announcement that all Specialised Foundation Programme (SFP) applications will now fall under the Preference Information Allocation system posed serious issues.

Medical Student Committee

Our student funding campaign was endorsed by the Medical Schools Council, which wrote to each of the secretary of state for health in the four nations.

The committee responded to the government’s long-term workforce plan with a national survey on the current educational experience of medical students. The results, which showed students struggling for learning opportunities already due to overcrowding, were shared widely on social media. 

The committee supported a student who had missed UKFPO deadline due to difficulties with the platform.

Committee members joined DAUK co-chair Dr Matt Kneale at a meeting with the GMC to talk about their views in the GMC and how they might work together on shared events at universities and explaining the council’s work.

We responded to the UKFPO’s waiting list with statements sharing the frustration of those medical students still to be allocated jobs and those allocated outside of their top choices.

The statements were posted on our website and social media and shared with the media.

We also submitted freedom of information requests to NHS England to understand the true picture. The request was rejected but NHS England should publish data in their next annual report. 

And we have begun preparations for expanding the Medical Student Committee for the next academic year.

Communications and media

DAUK and its committee members regularly contribute to articles and broadcasts, and provide briefings and background material to journalists working on more in-depth pieces.

We are proactive in putting out comment on our website and social media, and sending it direct to journalists.

And we are quick to respond to requests, with someone being available to speak to a journalist in the majority of cases.

We are working hard to build good working relationships with health journalists including though networking at events such as the Medical Journalists’ Association recent symposium.

Our work to oppose the expansion of PA and AA roles has had real cut through and been highlighted in the media, including the BBC Online, Mail Online, the Telegraph and the i newspaper, as well as medical websites and publications.

We broke the threat to the funding of NHS Practitioner Health for hospital doctors through our social media channels and website, which was picked up by reporters and brought about a quick U-turn.

We have had some stunning media coverage for our GP committee, with the members regularly invited to comment in health publications such as GP Online and Pulse Online.

Dr Ellen Welch penned an opinion column in Metro putting the NHS workforce on the election agenda.

Dr Sarah Jacques bravely shared her emotional story with the Telegraph for a feature on general practice that also included contributions from our GP Lead Dr Lizzie Toberty and Dr Welch.

The general election has given us a chance to highlight GP issues.

Dr Steve Taylor, of our GP committee, welcomed the election as a chance to raise the profile of the GP crisis, but told GP Online it must not delay a funding uplift. He also spoke to Pulse for an article examining the under-spending on health since the last election.

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Trisha Suji, DAUK medical student lead, said it was ‘grossly unfair’ that students who have been left unallocated on the placeholder system will get only a few weeks’ notice of where they will start their first job as a doctor.

She said: “Final year medical students need to be allocated a place of work so they can plan and get on with their lives.

“Many will be moving away from home, some will have family, children, caring responsibilities and will need to put things in place.

“Some medical students have been sharing their frustrations on social media – and we share those frustrations.”

Journalist Alison Moore posted on X, formerly Twitter, said that there could be as many as 1,000 graduating doctors currently without jobs, and some may find out as late as 4 July.

She posted: “Their induction may start w/c 22 July leaving them 18 days to find a home. They will have applied as early as October.”

The numbers of students on the national reserve list has been growing in recent years, as seen on the UKFPO Reports.

‘Perfect storm’

Since 2019, medical practitioners have been on the occupation shortage list meaning local graduates are no longer prioritised for foundation jobs.

Dr Ajay Verma, a consultant gastroenterologist, posting on X, said: “This is the perfect storm, the change in the allocation process and a record number of applicants (from UK and abroad) means that there are 100s of final year medical students who don’t have a post as yet.

“There are lots of discussions with local hospitals to create additional posts (without additional funding).

“However this is a slow process and doesn’t help individual’s understandable anxiety. It is a scandal that there are future colleagues going through this uncertainty (and possible unemployment).”

Physician associates

Concerns have also been raised on social media that it appears some oversubscribed deaneries are welcoming physician associates (PA) onto new foundation-like programmes.

PAs who qualify after a two year masters course are replacing traditional doctor roles, their placement and education perhaps being prioritised over medical students who are about to qualify.

A post on X highlighted a new 12-month Secondary Care Foundation Programme (education programme) for PAs sharing elements of the traditional doctor teaching.

Trisha said: “The current allocation system for the UKFPO (the organisation that places doctors in their first jobs) does not appear to be functional.

“It does not serve final year medical students. A growing number of medical students are left unallocated year on year, with the problem only set to get worse when cohorts of new medical schools and expanded years begin to graduate.

“Graduates of UK schools must undertake foundation year one to receive their full license to practice as a doctor.

“For newly qualifying doctors the uncertainty, as they take their final exams, with no guarantee of where they might be working of living is beyond description.

Funding

“Neither is it appropriate for foundation schools and hospitals, as they try to place these medical students, to be left trying to create jobs without appropriate funding.

“It does not serve patients or the future of the NHS when the newest cohort of doctors are treated in this way.

“The system needs to change.”

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The Doctors’ Association UK (DAUK) shares the frustrations of the many medical students who have been allocated to foundation schools outside of their top choices.

One in four medical students have not been allocated their first choice school, while 740 students (7.6%) have been allocated to one outside of their top five.

Trisha Suji, DAUK medical student lead, said: “This is an important moment for all final year medical students in the UK who have just received their foundation programme allocations, determining where they will spend their first two years as a doctor.

“As those in the medical profession know, each foundation school covers large areas of the UK – sometimes entire countries.

“While most medical students have been allocated their top choice, one in four have not.

“For many, this means leaving their support networks behind, and due to differing pay scales in UK countries, leaves some earning less than their peers without choice.”

This is the first year that Preference Informed Allocation (PIA) has been used. It replaced the Score Based Allocation which combined EMP and SJT scores.

The UKFPO conducted modelling in January 2023 which found PIA resulted in 79.47% of applicants obtaining their first choice foundation school compared to the previous score-based system, which achieved 73.90% (¹).

DAUK recognises that this informed stakeholder engagement surveys, which found 66% of respondents favoured a move to PIA in June 2023 (²).

DAUK has reviewed the UKFPO 2024 allocation data document.

While we are pleased 75.42% of students, 4.4% more than last year, received their first preference, this was less than the modelling predicted and not the highest seen historically.

This was the second worst year since 2017 for allocating top five preferences, which fell by 2.59% compared to last year.

With 9702 allocations, this means nearly 740 students were allocated to Foundation Schools outside of their top five. 35 students will have been allocated to their 18th preference. (³)

Trisha said: “We share the frustrations of the many medical students that have been forced into this situation.

“It is disappointing that despite changing to this new system which has caused some students distress – a third did not vote for this change – those allocated to their top preferences do not appear to be significantly improved.

“We ask the UKFPO what support it is offering those students who have not been allocated their top preferences this year?

“And how does it plan to improve the numbers of students achieving their preferred preferences for the upcoming year?” 

2014

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2015

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2016

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2017

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2018

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2019

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2020

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2021

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2022

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SawBones was established in May 2022 by Ben and Dr Jen. SawBones was born out of Ben’s time in the armed forces and Jen’s current life as a doctor in Ireland. Military and emergency serviced based apparel has grown dramatically over the last ten years and Ben noticed that doctors were not being represented in the same way. With this in mind Ben decided that doctors deserved their own brand. The combination of Jen and their friends knowledge and Ben’s enthusiasm for service based apparel prompted the birth of SawBones. Ben was largely motivated to create the brand after hearing about both the daily hardships and life changing experiences his friends were enduring, both positive and negative. In 2021, the BMA released a report which detailed that up to a third of doctors have suffered abuse from patients. Furthermore, the suicide rate amongst doctors is 2-5 times higher than the average UK population. Being a doctor is also an extremely rewarding and vital occupation. The sacrifice and pride that comes with the profession is the reason SawBones exists. Ben has experienced his own MH journey and believes strongly in caring about people that protect us. There is often an unfortunate perception within medicine that doctors should be able to cope with the stresses and strains of the job due to their levels of intelligence and “expected” levels of resilience. However it is fact that this is a dangerous and unhealthy culture which exacerbates existing MH issues and causes new ones. Part of the mission behind the brand is to change this culture. As a result we have partnered up with “You Okay Doc” the leading MH charity for doctors in the UK. We will share their content and they will receive a 10% donation from each sale, alongside some special projects for them. Whether you are a first year medical student or an established consultant, SawBones is here to represent you. sawbonesapparel.co.uk

Unions demand fair compensation for dozens of doctors now unable to work because of debilitating symptoms, as DAUK’s Co-Vice Chair, Dr Kaveri Jalundhwala comments.

Read the full article here.

Doctors in a survey have unanimously rejected proposals to create an apprenticeship-style scheme as an alternative way of training doctors.

Members of the Doctors’ Association UK have voiced their opposition to the proposed new Health Education England doctor apprentice scheme in a survey, stating that the training is likely to be “inadequate.”

Health Education England (HEE) is creating an apprenticeship programme allowing candidates to receive an undergraduate medical degree without taking the traditional course.

During the programme, students could earn money alongside their studies, making entering the profession more financially accessible, HEE says.

HEE say the government-funded apprenticeship will “retain the same high standards of training”, and the British Medical Association say the proposals are “interesting and worthy of consideration”.

However, in a survey, Doctors’ Association UK members have voted unanimously to reject the proposals.

Chair of the association, Dr Jenny Vaughan, says: “Whilst we do not disagree with the general consensus of the scheme, which aims to diversify and widen participation in medicine, the question raised, is why it is necessary, considering there is a surplus of fully trained final year medical students unable to secure FY1 placements.”

She believes: “It is the background of several years of both theoretical learning and practical experience that doctors draw upon which enables them to deal with complexity.

“The current apprenticeship proposals are unclear about how standards will be achieved and maintained, meaning we are concerned apprentice trainees will lack this basic grounding and could be hazardous for patients.”

Dr Lizzie Toberty, of the Doctors’ Association UK, commented: “This apprenticeship scheme risks spending a lot of time and money to develop inadequately trained doctors. Without a thorough and rigorous grounding in the sciences we risk dumbing down our health system. If patients do not have access to doctors with adequate clinical knowledge their treatment will suffer.

“We strongly recommend HEE focus on making current medical school places more affordable and accessible to those from all backgrounds.”

Read the article here

Students were told that they could sit the exam at Pearson VUE testing centres or virtually from home, with online proctoring. However, many students were unable to get a slot at a testing centre and were forced to sit the exam online from home.

One student told The BMJ that she had been disqualified from her exam for taking notes on a blank notepad despite having sent an image of her desk, including the notepad, to her invigilator before the exam started.
Another student said that they had been disqualified for playing the audio of a video question out loud from their laptop speakers. Before doing so they had asked their invigilator whether this was allowed but received no response.

“They indicate that the treatment for some students undergoing the exams has been unfair, unacceptable, and in some cases inhumane,” they said. “This is the latest in a line of issues with the SJT [situational judgment test] delivery for this year, and we have serious concerns of the impact this will have on final year students.

“It’s clear that this is a totally unacceptable situation, and we will be taking this up with the UK Foundation Programme as a matter of urgency.”
They have written to the UKFPO calling for it to consider the allegations against Pearson VUE’s mishandling of the exam, review its online proctoring policy, and offer further extensions for students to resit the test where relevant. The UKFPO has said that fewer than 20 students—less than 0.25% of the 8000 applicants—were disqualified from the exam by a Pearson VUE invigilator for “prohibited actions.”

Mike Masding, co-chair of the UKFPO, said that he was working with applicants whose tests were discontinued and “where appropriate will offer the option to re-book.”

The Doctors’ Association said that, while it welcomed this “gesture of good will,” it had received complaints of students being forced to resit exams when they had covid-19 symptoms and of candidates not being allowed to use the toilets at test centres.

Freya Rhodes, medical student representative for the Doctors’ Association UK, said, “Telling students that their appeals have been rejected, and then days later offering resits, is a U turn that demonstrates poor preparation and lack of understanding from UKFPO and Pearson VUE.
“Furthermore, these resits have been offered with limited flexibility and extremely short notice, with some students being asked to take the examination while being unwell with covid-19. We must continue to support our final year students who are also facing the challenges of graduating during a pandemic.”

Read the full story here.

The difficulties emerged as medical schools said that ensuring students graduate and become doctors is now a priority.
Some students have found the situational judgement tests prematurely terminated because of technical difficulties – or because of, alleged, minor infractions of rules, the Doctors’ Association revealed.

It said candidates had finally been offered resits – but that problems are continuing. Students are being told they must undertake their resits even when they have COVID-19 and some have been told they cannot use toilets at test centres, the association said.

The tests have been contracted to a large educational company Pearson Vue and the association said it was concerned the company has a “monopoly” on postgraduate exams for at least four medical colleges.

Anna Sigston, who sits on the association’s medical student committee, said: “Candidates are being failed for errors within Pearson Vue’s system, but instead of apologising, they, along with the UKFPO, have refused to take responsibility and subsequent action while ignoring serious concerns. Reports of candidates not being allowed to use the toilet and of those forced to sit the exam while suffering from COVID-19 is not only immoral but refuses to take into account the needs of individuals. “This is only the start, as more medical exams occur virtually, more issues and inequalities will arise.”

Fellow committee member Freya Rhodes added: “These re-sits have been offered with limited flexibility and extremely short notice, with some students being asked to take the examination whilst being unwell with COVID-19. We must continue to support our final year students who are also facing the challenges of graduating during a pandemic.”

Read the full article here.